Coronavirus SARS-Cov2 (COVID-19)

[Kumar]

I have posted the weekly update of vaccination numbers and state ranks. This week was a teeny tiny bit better than last week. Hopefully we have gone past the bottom of the vaccine availability curve and the "wave" will pick up now ...

Probably if we have only total doses of covaxin and covishield, could we include that in weekly vaccine update. May be we can then start checking how much doses of each is administered each week based on previous week totals

[Kumar]

Very simple, clear and coherent explanation of optimal protocols for managing Covid-19 infection, and the rationale behind it.

A video from YouTube usually appears here. Please contact an administrator.

A video from YouTube usually appears here. Please contact an administrator.

The best video and very clear explanation! He is basically saying if u wait for your oxygen to drop, it may already be too late.this is a orthopedic doctor who has done lot of work with polio.

[jayakris]

Probably if we have only total doses of covaxin and covishield, could we include that in weekly vaccine update. May be we can then start checking how much doses of each is administered each week based on previous week totals

The Government does not release that data. It is like testing data on RT-PCR and Antigens. For one year, people like Rijo John and others have been asking, but ICMR never gave that split. Now there is no split available for Covishield and Covaxin, but every now and then they seem to tell the press some numbers in their statements. They do have the data, but don't care to tell us. I guess it will probably take a Supreme Court case now to get it out of them.

[jai_in_canada]

Very simple, clear and coherent explanation of optimal protocols for managing Covid-19 infection, and the rationale behind it.

The best video and very clear explanation! He is basically saying if u wait for your oxygen to drop, it may already be too late.this is a orthopedic doctor who has done lot of work with polio.

Yes, timing is very key. Doing the right things at the right time leads to better outcomes. Doing the right things at the wrong time or the wrong things at the right time or (worst of all) doing the wrong things at the wrong times leads to negative outcomes. When I see the people I know who have ended up in serious condition they have made one or more of the mistakes that he mentions.
1) Not being aware of when the first symptoms appear.
2) Ignoring the symptoms thinking they are the reaction to taking the vaccine - and thus seeking help too late.
3) Starting too soon on antibiotics, steroids, antivirals or oxygen - that is in the first 5 days after initial (mild) symptoms appear.
4) Clamouring pre-emptively for oxygen and Remdesivir based on wild rumours flying around on WhatsApp and Facebook - and in the process ignoring the timing and symptoms.
5) Seeking help too late (more than 5 days after initial symptoms and/or more than 2 days after symptoms worsen), by which time pulmonary thrombosis is likely in an advanced state so there is not much that can be done except oxygenation (passive or forced ventilation).
6) Not being put on antibiotics after 5-7 days of steroid treatment not realizing that bacterial pneumonia has set in.
7) Not monitoring for diabetes induced by steroid treatment for pre-diabetics and diabetics who were previously under control.

[jayakris]

+249K today with Uttarakhand, Chattisgarh and Jharkhand to come. Looks like something under 270K today.

Maharashtra said 516 deaths for today at first, but then a +484 went on top of that (must be reconciliation), and it is 1000 deaths from MAH today. Pretty clear that they are releasing data on earlier deaths little by little rather than throw in a big number at one time. Looks like we will hit 4000 deaths yet again nationally. It seems about 1200 reconciled deaths have been added in Maharashtra the last three days.

Karnataka is still in serious trouble. They only did 97K tests today and had a 39.7% positivity. This is horrible. Modi and Shah need to get involved and solve the test-kit issue in Karnataka.

[sameerph]

Just got this model on whatsapp-

Sutra Model on Covid

Looks pretty accuruate so far. They are predicting it will come down to around 15K by end June i.e almost back to January level which looks difficult at the moment. Lets see.

But, if not for anything, good historical graphs of daily infections of each state and each city within it available here.

[jayakris]

^^ Sameer, we had a good discussion on the model a few days earlier. They screwed up badly with extremely poor predictions from late March. They told the Central government on April 2nd that the peak would be around 100K, and we were already around 80K by then (possibly predictions from last week of March when we were about 65K). It was 400K just three weeks later after they said that to the Government's Covid Task Force.

I don't know what they are showing in that page. Seems like prediction for the next three days based on the data till any given day, or something like that. Because they have niot been predicting anywhere close to that well for longer term. They have gone on to some sort of a whatsapp blitz today though. I also got whatsapp messages on this today. No, that model isn't working well for India's purposes.

(I did think that their model was as good as any out there, based on reading the paper from late last summer, but Suresh pointed out that it is not working well, and then we saw an apology-like letter from Professor Agarwal and team that they had predicted things wrongly and told the Government on April 2nd. I think they didn't help the situation and quite possibly hurt it. Had they said 250K+ was coming soon like we had said here by March 29th, those in Delhi might have had all kinds of their alarm bells go off. Two weeks later Kejriwal was crying that he had only 6 hours of oxygen left).

[sameerph]

Oh, thanks, Jay, Did not remember the earlier discussion. But, then they look bold in predicting 15K at end June. I know it is difficult to predict but do you think it is realistic to get to that level by end June ?

[jayakris]

Oh, thanks, Jay, Did not remember the earlier discussion. But, then they look bold in predicting 15K at end June. I know it is difficult to predict but do you think it is realistic to get to that level by end June ?

I was thinking about that too. I seriously doubt it. We will drop pretty fast, which we can guess (for the same reason that JIC said today - that the virus exhausted population groups too fast and can't find people to infect). But most countries' second waves ended up stabilizing to higher (sometimes much higher) totals than did the first wave. The numbers after the third wave could be even higher. So I am only looking for something under 60K or so for the number we might come down to before we go up again (we may not even drop below 75K). We will struggle to bring it down below that. Coming down to 15K nationally will be quite unlikely.

The reason I feel (I could be wrong) is that the virus would have reached a lot more of the population pockets after 2 waves, and all kinds of mutations will be causing cases here and there (many of those mutations won't become dominant but they will be infecting those who fought off the earlier versions, before dying out).

[jayakris]

In fact, the problem in SUTRA is that they do not have enough of fundamental dynamics of disease spread in terms of mutations. In fact, none of the mathematical models of epidemiology, which SUTRA and a few foreign models are based on, seem to have a good handle on that. For one wave, once it gets going, the model may work fine. But then another wave may be taking shape and the right mutations may not happen for a while for that wave to start going up. In fact many mutations may be trying to start new waves but failing - which is another way to look at it. But all the mutations and spread that happens in various places continue (with a larger population pool) and more cases happen than at the bottom after the first wave. The bottom point before the third wave will be higher. If there is a 4th wave, the base before it could be even higher. You can check the graphs of the countries who have had 3 or more waves (almost all of them have had it. We are the only country yet to even finish a second wave). This aspect is very clear.

That SUTRA guys predict numbers similar to the end of the last wave, is the clearest indication of what is missing in their model, if I am right (I may not be, as always )

To add, I think right now the SUTRA team may be causing immeasurable damage to our national strategies, if they keeping talking of 15K minimum in late June. We should be expecting only around 75K to 100K minimum in a few weeks, and a third wave starting (as early as in another 3-4 weeks) before it can go any further down. If we do not vaccinate enough people in the right population segments in the next 2-3 months, we will lose a lot of lives. The Covid task force (and Modi) need to be on their toes for the next 8 weeks, in my opinion, to delay the third wave and observing where troubles start. The mathematicians/engineers behind SUTRA need to be careful and not repeat their mistake of making politicians and policy-makers relax.

[sameerph]

Our first wave ended somewhere in mid September 20 and then the numbers kept coming down till mid February. So, it was close to 5 months gap between end of first wave and the start of second.

Jay, are you saying third wave can start as early as in 3-4 weeks time. Any specific reason you feel that the gap between second and third wave will not be as much as between first and second? Is it based on pattern of other countries waves?

[jayakris]

Actually, I was saying that just to be prepared (because some countries did have a third wave start fairly soon; though most seemed to not take significantly faster time than between the 1st and 2nd). We just need to have the worst case scenarios planned, unlike for the second wave. Since it was 5 months of drops from early September to February 10th before we started on the second wave, chances for it to start earlier than 3 or 4 months from May 15th are probably not too high. But by Aug-Sep, we better have a lot of people vaccinated. Then the third wave will not be an issue and can even be prevented.

But if we take till September to go down to 50K, that will be a lot of cases and deaths too. So, hopefully we will drop faster and then hold steady at a low number without a start of the 3rd wave. Let us see. Need to closely observe.

[jayakris]

We end the day with +263K... This was from 1921K tests, at 13.69%... So, the positivity keeps dropping nicely. The 7-day average of daily cases fell by about 9500 to 319K

Uttarakhand also added an 87 of reconciled deaths. That and the ongoing MAH reconciliation caused the deaths to hit our all-time-high of 4334 (but only about 3800 needs to be counted for today).

Vaccinations continue to be lukewarm. It was only 1.48M by 8 pm today (but 1.24M were first doses). Now that there is more vaccine stock with the states, I am not sure why the numbers are not going up. I am guessing that they are scheduling at a lag of a few days for new vaccine supply that happened only in the last few days, so maybe it will pick up later this week.

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ICMR Update: 318,292,881 total tests... Monday tests: 1,869,223

[jayakris]

There was a Govt press release on blood clot issues from our vaccinations, today - https://pib.gov.in/PressReleasePage.aspx?PRID=1719293

This is based on the National AEFI (Adverse Event Following Immunization) committee's review of data as of Apr 3rd, by when we had done 75,435,381 doses (Covishield – 68,650,819; Covaxin – 6,784,562)

The AEFI Committee has completed an in-depth case review of 498 serious and severe events, of which 26 cases have been reported to be potential thromboembolic (formation of a clot in a blood vessel that might also break loose and carried by the blood stream to plug another vessel) events – following the administration of Covishield vaccine – with a reporting rate of 0.61 cases/ million doses.

There were no potential thromboembolic events reported following administration of Covaxin vaccine.

AEFI data in India showed that there is a very miniscule but definitive risk of thromboembolic events. The reporting rate of these events in India is around 0.61/million doses, which is much lower than the 4 cases/million reported by UK’s regulator Medical and Health Regulatory Authority (MHRA). Germany has reported 10 events per million doses.

It is important to know that thromboembolic events keep occurring in general population as background and scientific literature suggests that this risk is almost 70 per cent less in persons of South and South East Asian descent in comparison to those from European descent

So it is 1/7th the rate of UK and 1/17th of that in Germany. I didn't know that S.Asians were particularly less susceptible to thromboembolic events. Interesting!!

[jayakris]

Haha, it is like somebody read my note the other day about Odisha. An article today on the topic that nobody had really looked into. The ridiculously low death total in ODI -- Bodies incinerated at one crematorium outnumber Odisha’s total COVID-19 toll (The Hindu)